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Insurance Claims Examiner

7 days ago

Jeddah, Makkah Province, Saudi Arabia My Clinic KSA Full time

My Clinic KSA is a leading multispecialty outpatient care provider in Saudi Arabia, dedicated to delivering exceptional patient experiences. We are seeking an Insurance Claims Examiner to join our team and help us achieve our mission.

About the Role

This exciting opportunity involves determining insurance coverage, examining and resolving medical claims, documenting actions, and ensuring legal compliance.

Main Responsibilities:

  • Evaluate requests medically and according to the Basic CCHI policy and patient insurance Table of Benefits (TOB).
  • Handle submissions through NPHIES and/or different insurance companies' portals within specific timeframes.
  • Follow up on replies from insurance companies.
  • Communicate with My Clinic's medical team for justification if required.
  • Inform My Clinic's operation teams (Reception and customer service) about insurance companies' decisions.
  • Prepare trackers for abnormal trends (investigations and medications) to aid awareness sessions with doctors, reducing medical rejections.
  • Verify flexible timing options.
  • Take accountability and responsibility for incorrect Policy decisions.

Requirements:

  • Degree-educated in Medical/business-related subjects.

Essential Skills:

  • Excellent command of oral and written English & Arabic.
  • Proficient in Microsoft Office Suite or related software.
  • Detail-oriented.
  • Strong problem-solving skills and ability to strategize solutions.
  • Analytical mindset and comfort working with numbers.
  • Good teamwork and communication skills dealing with internal and external customers.